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IM4 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Third spacing manifestations

A
  • Decreased urine output
  • Increased heart rate
  • Decreased BP, Decreased CVP
  • Edema
  • Increased weight
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2
Q

What is the most important assessment for electrolyte balance?

A

Daily weight *
Nutritional, health history, meds

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3
Q

Fluids move with

A

Osmosis

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4
Q

Sodium potassium pump

A

How the body regulates sodium by active transport

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5
Q

Intracellular fluid (ICF)

A

Fluid inside cell

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6
Q

Extracellular fluid (ECF)

A

Fluid outside of cell
- Intravascular
- Interstitial
- Transcellular

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7
Q

Intravascular fluid

A

contains plasma, liquid part of blood

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8
Q

Interstitial fluid

A

Surrounds cell, lymphatic

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9
Q

Decrease in oncotic pressure

A

loss or decrease is plasma albumin (pregnancy)
results in EDEMA

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10
Q

Increase in capillary permeability may be caused by

A
  • Inflammation
    -Immune response (burns, crushing injuries, neoplastic disease, cancer, allergic reactions)
    results in EDEMA
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11
Q

Increase in hydrostatic pressure may be caused by

A
  • Venous obstruction
  • Sodium and water retention
    results in EDEMA
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12
Q

Reasons for abnormal fluid movement

A
  • Decrease in oncotic pressure
  • Increase in capillary permeability
  • Increase in hydrostatic pressure
  • Obstruction of lymph channels
    results in EDEMA
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13
Q

Obstructions of lymph channels may be caused by

A
  • Tumors
  • Inflammation
  • Surgical removal
    results in EDEMA
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14
Q

Kidneys

A

major filter
must have enough pressure for kidneys to do their job!

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15
Q

hypothalamus

A

gives perception of thirst

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16
Q

adrenal cortex

A

regulates sodium by releasing aldosterone
(where Na goes, water flows)

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17
Q

pituitary gland

A

releases/inhibits adh (holding/letting go of water)

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18
Q

If a patient has any issues with their these 4 things, fluid will not be balanced (How fluids are regulated)

A

adrenal cortex
hypothalamus
kidneys
pituitary gland

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19
Q

Lung edema

A

pleural effusion

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20
Q

Cardiac edema

A

pericardial effusion

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21
Q

belly edema

A

ascites

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22
Q

feet edema

A

peripheral edema

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23
Q

edema everywhere

A

anasarca

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24
Q

With edema, what should you make sure your assessment includes?

A

compare bilaterally

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25
Q

Complications of edema

A
  • Pressure injuries
  • Infections
  • Life threatening influence (brain, lungs, larynx)
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26
Q

Transcellular fluid

A

cerebral spinal, pleural

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27
Q

Isotonic

A

iso means same
-given to replace fluid loss
- 280-300
-D5W, NS, LR

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28
Q

hypotonic

A

fluid going inside, cells swell (hippo)
osmolality is lower than plasma (<280)

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29
Q

hypertonic

A

fluid going outside, cells shrink
osmolality is higher than plasma (>300)

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30
Q

Osmolality

A

Concentration of all chemical particles found in the fluid part of the blood

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31
Q

Normal osmolality levels

A

280-300

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32
Q

If sodium is low, osmolality will be

A

LOW!

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33
Q

Factors decreasing osmolality

A

(Less than 280)
- Fluid volume excess!
- SIADH
- Renal failure
- Hyponatremia (low na, low osm.)
- Overhydration

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34
Q

Use D5W (hypotonic) with caution in

A

patients with diabetes
neuro patients (brain swelling)
cerebral edema

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35
Q

What is the only solution that can be given with blood?

A

normal saline

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36
Q

What symptom do you need to watch for when giving NS

A

shortness of breath!!

36
Q

Use NS with caution in

A

patients with renal impairment
CHF
pulmonary edema

36
Q

What do you need to monitor in patients receiving a hypotonic solution?

A

LOC

37
Q

Hypotonic solutions

A

think low numbers!
1/2 NS
1/3 NS
1/4 NS
D2.5W

38
Q

Use hypertonic solutions with caution in patients with

A

diabetes
impaired heart or kidney function

39
Q

hypertonic solutions

A

think high numbers!
5% Dextrose, 10% dextrose

40
Q

most common colloid

A

albumin

41
Q

what do colloids do?

A

pull fluid into the bloodstream

42
Q

Monitor patients when infusing colloids for

A

fluid overload
-increased bp
-dyspnea
-bounding pulse
-anaphylaxis
monitor electrolytes if giving diuretics

43
Q

fluid volume deficit causes

A

vomiting – HOW LONG
dehydration – HOW LONG
trauma
burns
diuretics

44
Q

fluid volume overload causes

A

rapid infusion rate
hepatic, cardiac, or renal disease
more common in elderly

45
Q

fluid volume overload prevention

A

infuse IVF via pump
monitor closely

46
Q

fluid volume overload intervention

A

decrease iv rate
monitor vs, respiratory status
high fowlers

47
Q

Normal sodium levels

A

135-145

48
Q

chloride follows

A

sodium

49
Q

function of sodium

A

maintains proper balance of water and minerals
-BP
-Blood volume
-pH balance

50
Q

Hyponatremia causes

A

“NONA”
-Na excretion w renal problems, NG suction, vomiting, diuretics, sweating, diarrhea, DI
-Overload of fluid
-Na intake low (low salt diet, NPO)
-Antidiuretic hormone oversecretion (SIADH)

51
Q

sodium is regulated by

A

ADH
Aldosterone: hold Na in body by blocking it at kidney
Sodium potassium pump: moves Na out of cells

52
Q

S/S of hyponatremia

A

(lots of neuro)
SALT LOSS
Seizures and stupor
Abdominal cramping, attitude changes (confusion)
Lethargic
Tendon reflexes diminished, trouble concentrating
Loss of urine & appetite
Orthostatic Hypotension, Overactive bowel sounds
Shallow respirations
Spasms of muscles

53
Q

rule of thumb for treating hyponatremia

A

serum Na must not be increased >12 meq/L in 24 hours

54
Q

treatment for hyponatremia (water gain)

A

restricting h2o is safer than giving Na
(restrict 800ml/24hr)
diuretics
hypertonic solution

55
Q

Patients on lithium with low Na

A

can get lithium toxicity due to urinary sodium loss

56
Q

hypernatremia causes

A

(HIGH SALT)
Hypercortisolism
Increased intake of sodium
GI feeding without adequate water
Hypertonic solutions
Sodium excretion decreased with corticosteroids
Aldosteronism
Loss of fluids
Thirst impairment

57
Q

Hypernatremia S/S

A

(FRIED) neuro*
Fever, flushed skin
Restless, really agitated
Increased fluid retention
Edema, extremely confused
Decreased urine output, dry mouth/skin

58
Q

Hypernatremia treatment

A

decrease serum Na level gradually (0.5 over 48 hrs)
monitor for neuro changes
hypotonic solution
desmopressin

59
Q

Potassium levels

A

3.5-5

60
Q

Potassium is a major electrolyte in

A

intracellular fluid

61
Q

Hypokalemia causes

A

(body is trying to DITCH potassium)
Drugs – #1 cause, diuretics, laxatives, corticosteroids
Inadequate consumption of K
Too much water intake
Cushings Syndrome
Heavy fluid loss

62
Q

Hypokalemia S/S

A

everything is going to be LOW and SLOW
*** lethal cardiac dysrhythmias
-weak pulse
-shallow respirations
-confusion, weak
-lethargy
-lots of urine
-low bp and heart

63
Q

renal system is important in keeping balanced

A

potassium (potassium leaves body by kidneys)

64
Q

body does not conserve

A

potassium
it can still leave body by urine if levels are low

65
Q

renal loss of K

A

diuretics - loop, thiazides
hyperaldosteronism
high dose sodium pcns
large dose corticosteroids

66
Q

Increased aldosterone causes

A

an increased retention of Na and water & increases urinary excretion of potassium

67
Q

hypokalemia cardiac changes

A

** decreased strength of contraction

68
Q

digoxin toxicity and potassium

A

low blood levels of potassium

69
Q

oral K+ supplements

A

minimize GI irritation
give with food!

70
Q

IV K+ supplement

A

DO NOT give IVP
must be diluted
must use IV pump
max dose - 60meq at a time

71
Q

HYPERkalemia causes

A

CARED
Cellular movement (ICF to ECF)
Adrenal insufficiency
RENAL FAILURE - #1 cause
Excessive potassium intake
Drugs - Ace, Beta, NSAID

72
Q

HYPERkalemia S/S

A

MURDER
Muscle weakness
Urine production little to none
Respiratory failure
Decrease cardiac contractility
Early signs of muscle twitches/cramps
Rhythm changes

73
Q

HYPERkalemia cardiac changes

A

slows heart rate (bradycardia)
ECG changes

74
Q

HYPERkalemia treatment

A

cation-exchange resins
POLYSTYRENE SULFONATE (KAYEXALATE)

75
Q

meds containing potassium

A

ace inhibitors
beta blockers
NSAIDS

76
Q

Ca gluconate

A

does not lower potassium
helps protect heart

77
Q

Magnesium levels

A

1.6-2.6

78
Q

magnesium maintains

A

regulates muscle and nerve fx
blood sugar levels
immune system
*normal cardiac fx

79
Q

hypomagnesemia is associated with

A

hypokalemia
low mg makes low k resistant to treatment!!

80
Q

Hypomagnesemia S/S

A

tight airway! (ABCs)
difficulty swallowing, stridor
N/V/D
increased BP and HR

81
Q

Most common cause of hypomagnesemia

A

chronic alcoholism

82
Q

Nursing interventions for hypomagnesemia

A

SIM
Safety with swallowing
IV mg + sulfate
Monitor respiratory status

83
Q

foods rich in mg

A

dark choc
avocado
milk
peas
peanut butter
oranges
nuts
bananas

84
Q

Hypermagnesemia S/S

A

heart- calm and quiet
Lung - low and shallow
hypoactive bowels
lethargy
weak

85
Q

Causes of hypermagnesemia

A

antiacids
renal failure
potassium excess

86
Q

nursing interventions for hypermagnesemia

A

HIM
Hemodialysis
IV calcium gluconate
Monitor labs

87
Q
A

IM4 (11 decks)

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